UropathologyIntermediateAnnotated

Prostatic adenocarcinoma, Gleason pattern assessment

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Clinical history

66-year-old with PSA 8.4 ng/mL.

Specimen

Transperineal targeted biopsy · Stain: H&E

Microscopic description

Infiltrative small glands with prominent nucleoli and absent basal cells, with a minority component of fused and poorly formed glands.

Diagnostic question

What percentage of pattern 4 is present and how does it affect the grade group?

Reveal differential diagnosis
  • Atypical small acinar proliferation
  • Adenosis
  • High-grade prostatic intraepithelial neoplasia
Reveal final diagnosis

Acinar adenocarcinoma, Gleason score 3+4=7, Grade Group 2

Learning points

  • Report percentage of pattern 4
  • Assess perineural invasion and core involvement
  • Basal cell markers help exclude mimics

Self-assessment

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